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BILLING_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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EIGHT MILE
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3749
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2300 - Underground Storage Tank Program
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PR0501459
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BILLING_PRE 2019
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Entry Properties
Last modified
3/28/2021 11:23:15 PM
Creation date
11/4/2018 2:17:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0501459
PE
2333
FACILITY_ID
FA0005109
FACILITY_NAME
EIGHT MILE ROAD RANCH
STREET_NUMBER
3749
Direction
W
STREET_NAME
EIGHT MILE
STREET_TYPE
RD
City
LODI
Zip
95240
APN
05520004
CURRENT_STATUS
02
SITE_LOCATION
3749 W EIGHT MILE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\E\EIGHT MILE\3749\PR0501459\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
11/15/2012 8:00:00 AM
QuestysRecordID
85010
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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Underground Storage Tank Program - Farm Tank Information Form <br /> FACILITY/SITE INFORMATION (Complete this form for each FARM TANK location.) <br /> F FARM or BUSINESS NAME CONTACTNAME <br /> A B�l1Uf/f/ <br /> C ADDRESS(Stat address of TANK location) PHONE k (with arca code) <br /> I <br /> L <br /> I CITY STATE I ZIP CODE I NEAREST CROSS STREET <br /> T <Gl/ cfl 9.52410 7/'Z otW A.41� <br /> Y CHECK HERE if this ADDRESS should be used for Legal Notification <br /> JAN <br /> OPERATOR INFORMATION &ADDRESS (Complete If information different from above.) N 8 <br /> O NAME G(� �jE�� , j(�6C OPERA"!'ORLON"CACPNAtvlL`' <br /> E MAKING or STREET ADDRESS OPERATOR PHONE N (with area code) <br /> R <br /> T CITY STA'IB ZIP CODE <br /> 0 SWCf' . y'Wez 14W S&912 <br /> - <br /> R ✓ CFIECK HERE is this ADDRESS should be used for Legal Notification. <br /> PROPERTY OWNER INFORMATION &ADDRESS (Complete if different from above.) <br /> NAME OWN ER CONTACT NAME <br /> 0 <br /> NMAILING or STREET ADDRESS OWNER PHONE N(with area code) <br /> E <br /> R CITY STATE ZIP CODE <br /> CHECK HERE if this ADDRESS should be used for Legal Notification <br /> CHECK APPROPRIATE BOX <br /> T ACTIVE FARM TANK SITE (One or more underground TANKS > 1,100 gallon capacity) <br /> Y <br /> P EXEMPT FARM TANK SITE (AU.underground TANKS at site = to or < 1,100 gallon capacity) <br /> E ✓ PERMANENTLY CLOSED FARM TANK SITE (ALL underground TANKS at site removed or closed in place) <br /> UNDERGROUND TANK INFORMATION (List additional tank Information on separate sheet If needed.) <br /> T TANK SIZE CHEMICALS STORED ESIIMAI'[il)DATE LAST USED MITIIOD OF CLOSURE DATE OF REMOVAL Olt <br /> A (GALLONS) CURRENTLY OR PREVIOUSLY IF CURRENTLY EMPTY IF PERMANENTLY CLOSED CLOSURE.IN PLACE <br /> N <br /> K <br /> I <br /> N <br /> F <br /> O <br /> TIUS FORM HAS BEN COMUNDER PENALTY OF PERJURY,AND T'O TIIE REST OF MY KNOWLEDGE,IS TRUE AND CORIA'C"T. <br /> NAME TITLE DATE 2-3 <br /> OFFICE USE ONLY <br /> SW[iEPS N (OMEN DE DLS'1'CODE N ACIIVE IKi'I' N UG'.MYI'UG'IN CL(ASED Uri] I SWEET'S PItOM/SUD CODE DA I V <br /> EH 23 044(12/a8) <br />
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